Medicare proposal to pay less for dialysis worries some in Topeka

Roberta Henley, of Topeka, works on a crossword puzzle will receiving dialysis Monday morning at Da Vita dialysis center, 634 S.W. Mulvane. Dialysis is used to treat chronic kidney disease, which affects about 26 million Americans. Medicare has proposed cutting the rate it pays to dialysis centers starting in January.

For Roberta Henley, chronic kidney disease means long hours of treatment, watching everything she eats and drinks and keeping track of dozens of pills with the help of her husband, R.E. Henley. Now, they worry Medicare will add one more struggle for them to deal with.

R.E. Henley said Roberta, who was born with only one kidney, has been receiving treatment for kidney failure for almost 16 years. She used peritoneal dialysis, which pumps fluid to clean the blood into the abdomen and then drains it, at home for more than 11 years before that method stopped working, he said. For the past five years, they have come to the Da Vita clinic at 634 S.W. Mulvane for hemodialysis, which filters her blood by moving a small amount at a time through a machine for about three hours three times per week. Roberta said she also takes more than 20 pills daily as part of her treatment.

Medicare and their secondary health insurance policy cover most of the cost of Roberta’s treatments, Henley said, but they still have to meet a deductible of more than $400 and cover about $2,300 for medications while they are in the Medicare “donut hole.” The donut hole refers to the gap where Medicare stops paying for medications after costs hit $2,970. It begins providing coverage after medication costs rise above $4,700, triggering “catastrophic coverage.”

Medicare has proposed a rule to cut its payments to dialysis centers from an average of $246.47 per treatment to $216.95 starting in January. Most patients go in for treatment three times per week, though that varies with each patient’s condition.

Tami Holzman, spokeswoman for Medicare, said the cut was part of the American Taxpayer Relief Act, meaning Medicare is bound by law to follow it. The act was better known as the deal to avert going over the “fiscal cliff” at the start of 2013.

Henley said they are concerned about the planned cuts, and he thinks the government should cut spending on foreign aid before reaching into dialysis reimbursements.

“The problem is you don’t know what’s going to happen until after it happens,” he said. “These are people that have paid their dues, paid their taxes.”

The National Kidney Foundation estimated about 26 million Americans have chronic kidney disease. Not all of those people are receiving dialysis treatments, but if the disease progresses to a point where most kidney function is lost, dialysis and kidney transplants are the only options to extend life.

The kidneys’ main job is to filter impurities and excess fluids from the blood to be expelled as urine, though they also produce hormones that strengthen bones, help produce red blood cells and play a part in regulating blood pressure, according to the National Kidney Foundation. Dialysis acts as a substitute for the body’s filtering system, and patients have to take medications and vitamin and mineral supplements to replace the kidneys’ other functions.

Krista Kruggel, a social worker at Da Vita dialysis clinic, said the center has about 170 regular patients. About 40 more do peritoneal dialysis at home, and about 30 use home hemodialysis machines, she said.

About 85 percent of Da Vita’s patients are covered by Medicare now, said Colleen Kasson, who is vice president of Da Vita’s division covering Kansas and Oklahoma and is also a registered nurse. Patients without insurance become eligible for Medicare coverage after three months, if they aren’t already eligible, according to information on the Medicare website. If a patient has private insurance, that is the primary payer for another 30 months, after which Medicare becomes the primary payer.

Medicare pays less than most private insurers for dialysis, Kasson said, so insurance companies essentially subsidize Medicare until their patients make the switch — raising the amount they pay in the short-term but allowing them to avoid paying for decades worth of treatments a patient might need.

“Currently, the rate Medicare provides to us doesn’t cover the cost of providing dialysis,” she said.

Larger facilities, like the one in Topeka, wouldn’t be hit as hard as smaller ones, Kasson said. The Da Vita clinics in Ottawa, Paola and Sabetha might have to cut their hours, reduce staff or even close, forcing patients to drive farther for treatment, she said.

Kruggel said cutting services isn’t an option there because of the number of people who need dialysis to extend their lives. The only option will be to pass the costs not covered by Medicare on to insurers, and some of that cost will fall on patients, she said.

“If Medicare cuts even more, it’s going to be even more of a financial burden for our patients,” she said. “For the patients that don’t have insurance, I’ve seen bills that cost more than my home.”

Medicare is accepting comments on the proposed change through Aug. 30. They can be left online at www.regulations.gov or mailed to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1526–P, P.O. Box 8010, Baltimore, MD 21244–8010.